Acute Asthma in Adults

Rodrigo, Gustavo J.; Rodrigo, Carlos; Hall, Jesse B.

doi:10.1378/chest.125.3.1081

Cited by 247 publications

(196 citation statements)

References 208 publications

(164 reference statements)

Supporting

Mentioning

144

Contrasting

Unclassified

Order By: Relevance

“…(11) It is well established that measurements of lung function, such as FEV 1 /PEF, provide an objective evaluation of airway obstruction and constitute an integral part of the assessment of disease severity (static assessment) and of the response to therapy (dynamic assessment) in any patient over 5 years of age. (1,3,12) This suggests that acute asthma patients are being admitted, treated and discharged inappropriately. The reasons for the lack of more intensive use of PEF determination in emergency rooms are not clear, although influencing factors include emergency room congestion and physician time fragmentation, both of which are inherent to the day-to-day practice of emergency medicine.…”

Section: Discussionmentioning

confidence: 99%

The study of severe asthma in Latin America and Spain (1994-2004): characteristics of patients hospitalized with acute severe asthma

et al. 2009

View full text Add to dashboard Cite

Objective: Studies assessing the characteristics and management of patients hospitalized with asthma have been limited to a small number of facilities and have evaluated short time periods. The present study evaluated long-term changes among hospitalized asthma patients at a large number of facilities. Methods: This was a retrospective, hospital-based observational case series, designated the Study of Severe Asthma in Latin America and Spain, which was conducted in Spain and in eight Latin-American countries. We reviewed the hospital records of 3,038 patients (age range, 15-69 years) hospitalized with acute severe asthma at one of nineteen tertiary-care hospitals in 1994, 1999 and 2004. Results: Over time, the use of inhaled corticosteroids and long-acting β 2 agonists increased significantly, whereas the use of theophylline as a controller medication decreased. The utilization of pulmonary function tests also increased. There was a significant reduction in the mean hospital stay (8.5 days, 7.4 days and 7.1 days in 1994, 1999 and 2004, respectively, p = 0.0001) and a significant increase in the mean of the lowest arterial pH at hospital admission. In contrast, there was a significant decrease in the proportion of cases in which PEF was determined in the emergency room (48.6% in 1994 vs. 43.5% in 2004, p = 0.0001). We found the quality of asthma management and care to be generally better in Spain than in Latin America. Conclusions: Although there have been certain improvements in the management of asthma between severe exacerbations and during hospitalization, asthma management remains suboptimal in Spain and, especially, in Latin America.Keywords: Status asthmaticus; Asthma/therapy; Hospitalization. ResumoObjetivo: Estudos que avaliem as características e o gerenciamento de pacientes asmáticos hospitalizados têm sido limitados a um número pequeno de serviços e a curtos períodos de duração. O presente estudo avaliou alterações de longo prazo de pacientes asmáticos hospitalizados em um grande número de serviços. Métodos: Estudo retrospectivo, observacional, de base hospitalar, denominado Estudo sobre Asma Grave na América Latina e Espanha, realizado na Espanha e em oito países da América Latina. Foi realizada uma revisão dos registros hospitalares de 3.038 pacientes (variação de idade, 15-69 anos) hospitalizados com asma aguda grave em um dos 19 hospitais terciários em 1994, 1999 e 2004. Resultados: Ao longo do tempo, o uso de corticosteroides inalatórios e de β 2 -agonistas aumentou significativamente, ao passo que o uso de teofilina, como medicação de controle, decaiu. A utilização de testes de função pulmonar também aumentou. Houve uma redução significativa da média do tempo de internação (8,5 dias, 7,4 dias e 7,1 dias em 1994, 1999 e 2004, respectivamente; p = 0,0001) e um aumento significativo da média do menor pH arterial na admissão. Em contrapartida, houve uma diminuição significativa na proporção de casos submetidos ao PFE no pronto-socorro (48,6% em 1994 vs. 43,5% em 2004; p = 0,0001).O tratamen...

show abstract

Section: Discussionmentioning

confidence: 99%

The study of severe asthma in Latin America and Spain (1994-2004): characteristics of patients hospitalized with acute severe asthma

et al. 2009

View full text Add to dashboard Cite

show abstract

“…7,8 A small study of asthma found that NIV was associated with a reduction in PaCO 2 during the early hours of use and that mortality and complications were not increased in those who subsequently required intubation. 9 However, in another study of 27 patients managed with NIV, 2 of the 5 patients requiring intubation died. 10 In 12 In our series, NIV was used in 10 patients, 4 of whom were subsequently intubated.…”

Section: Discussionmentioning

confidence: 98%

Increasing severity of status asthmaticus in an urban medical intensive care unit

Elsayegh

Saito

Eden

et al. 2008

Journal of Hospital Medicine

View full text Add to dashboard Cite

BACKGROUND:Life‐threatening status asthmaticus (SA) requiring intensive care is a major concern given the rising prevalence of asthma. We examined episodes of SA requiring admission to the medical intensive care unit (MICU) of an urban hospital center.METHODOLOGY:The charts of patients admitted to the MICU of an urban hospital center with a diagnosis of SA during the 5‐year period 2002–2006 were reviewed retrospectively. These results were compared with those of a previously published experience at our institution from 1995 to 1999.RESULTS:The medical records of 84 MICU admissions for SA were reviewed. There were 61 women (5 pregnant). The mean age was 44 years. Use of cigarettes or illicit drugs was found in 51% and 30%, respectively. Mechanical ventilation (MV) was required in 76% of admissions. Noninvasive ventilation was used in 10 patients. Neuromuscular blockade (NMB) was needed in 9% of admissions. The highest average PaCO2 during the first 24 hours was 67 mm Hg. Median duration of MV was 4.4 days. Six patients died, 3 of whom sustained prehospital cardiac arrest. Compared with the patients in the preceding 5‐year period, the more recent patients had greater use of illicit drug and cigarettes. Patients presented with more severe asthma, as reflected by a higher PaCO2 and an increased duration of MV.CONCLUSIONS:During the recent 5‐year period, we found a trend toward increasing severity of SA, as indicated by the degree of respiratory acidosis, need for NMB, and longer duration of MV. Access to medical care and cigarette and illicit drug use remain potential targets of primary intervention. Journal of Hospital Medicine 2008;3:206–211. © 2008 Society of Hospital Medicine.

show abstract

“…Although airway blood and vascular engorgement have been proposed to contribute to airway narrowing and hyperresponsiveness in asthma, the reported data are conflicting [44,45]. Despite the prominent effects of inhaled corticosteroids on airway blood flow, the immediate impact of inhaled corticosteroids on lung function appears to be marginal in patients with acute asthma [21,46].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Inhaled corticosteroids reduce asthma-associated airway hyperperfusion through genomic and nongenomic mechanisms

Horváth¹,

Vasas²,

Wanner³

2007

Pulmonary Pharmacology & Therapeutics

View full text Add to dashboard Cite

show abstract

Acute Asthma in Adults

Cited by 247 publications

References 208 publications

The study of severe asthma in Latin America and Spain (1994-2004): characteristics of patients hospitalized with acute severe asthma

The study of severe asthma in Latin America and Spain (1994-2004): characteristics of patients hospitalized with acute severe asthma

Increasing severity of status asthmaticus in an urban medical intensive care unit

Inhaled corticosteroids reduce asthma-associated airway hyperperfusion through genomic and nongenomic mechanisms

Contact Info

Product

Resources

About